Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel

Abstract Objective To identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel. Background Studies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access. Methods We conducted a modified Delphi stakeholder panel anchored by a systematic review. Panelists (N = 20) represented diverse stakeholder groups including patients, providers, policy makers, purchasers, and payers of healthcare services, predominantly from the Veterans Health Administration. A pre-panel survey addressed over 80 aspects of healthcare organization management of access, including defining access management. Panelists discussed survey-based ratings during a 2-day in-person meeting and re-voted afterward. A second panel process focused on each final priority and developed recommendations and suggestions for implementation. Results The panel achieved consensus on definitions of optimal access and access management on eight urgent and important priorities for guiding access management improvement, and on 1–3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation. Priorities address two organizational structure targets (interdisciplinary primary care site leadership; clearly identified group practice management structure); four process improvements (patient telephone access management; contingency staffing; nurse management of demand through care coordination; proactive demand management by optimizing provider visit schedules), and two outcomes (quality of patients’ experiences of access; provider and staff morale). Recommendations and suggestions for implementation, including literature references, are summarized in a panelist-approved, ready-to-use tool. Conclusions A stakeholder panel informed by a pre-panel systematic review identified eight action-oriented priorities for improving access and recommendations for implementing each priority. The resulting tool is suitable for guiding the VA and other integrated healthcare delivery organizations in assessing and initiating improvements in access management, and for supporting continued research.

Download Full-text

Primary Care for Homeless Veterans: A Systematic Review of the Homeless Patient Aligned Care Team (HPACT)

10.1101/2021.03.30.21254619 ◽

2021 ◽

Author(s):

David Rosenthal ◽

Benjamin A. Howell ◽

Erin Johnson ◽

Katherine Stemmer Frumento ◽

Jack Tsai

Keyword(s):

Systematic Review ◽

Primary Care ◽

Patient Experience ◽

Program Implementation ◽

Original Data ◽

Emergency Department Utilization ◽

Original Research ◽

Veterans Health ◽

Health Administration ◽

Homeless Veterans

AbstractBackgroundIn 2011, the Veterans Health Administration (VHA) implemented homeless-tailored primary care medical home models, called the Homeless Patient Aligned Care Teams (HPACT) to improve care for homeless Veterans. The aim of this study was to describe the existing peer-reviewed literature on HPACTs by systematically reviewing studies published since 2011 to date.MethodsWe conducted a systematic review of peer-reviewed studies published from 2011 to June 2019 to evaluate the literature since the inception of the VHA’s Homeless PACT program implementation. We included original research articles evaluating the Homeless PACT and excluded those that did not contain original data.ResultsOf 379 studies screened, 20 studies met our inclusion criteria and were included for analysis. Given wide variability in research designs and outcome measures, a narrative review was conducted. The 20 included studies were categorized into 3 groups: Early HPACT pilot implementations; Association of HPACT clinics with quality and utilization; and Specialized programs within HPACTs. Observational findings suggest reductions in emergency department utilization, improvements in primary care treatment utilization, engagement, and patient experience; but limited rigorous studies exist beyond single site pilots and a few large observational cohort studies.DiscussionThe HPACT model has been successfully implemented in VHA medical centers throughout the country with multiple studies showing increased primary care engagement and improved patient experience; however, further studies are needed about quality, utilization and whether the model can be implemented outside the VHA system.Registration Number/Funding sourcenone

Download Full-text

Do You Get What You Measure? Research Opportunities Based on the Veterans Health Administration Experience

Accounting Horizons ◽

10.2308/acch-50731 ◽

2014 ◽

Vol 28 (2) ◽

pp. 385-413 ◽

Cited By ~ 1

Author(s):

Nicole Thibodeau ◽

John Harry Evans ◽

Nandu J. Nagarajan

Keyword(s):

Healthcare Delivery ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Performance Incentives ◽

Healthcare Network ◽

Similar Patient ◽

Private And Public ◽

The U.S

SYNOPSIS Starting in 1995, the Veterans Health Administration (VHA) transformed a bureaucratic healthcare system into a performance-driven, patient-focused integrated healthcare network. The VHA's experience may offer lessons for private and public sector providers as the U.S. explores alternative healthcare delivery systems and payment methods. Similar patient-focused integrated systems are one of the hallmarks of the latest U.S. attempt to improve the quality and efficiency of healthcare delivery. The use of performance incentives to promote cooperation and innovation is also central to both the VHA and the U.S. reform. This study reviews the VHA's experience with an eye to identifying issues and potential research avenues for accounting researchers interested in the role of accounting information for control, coordination, and organizational change.

Download Full-text

Complementary and Integrative Health Approaches Are Underused Among Older Veterans With Musculoskeletal Pain

Innovation in Aging ◽

10.1093/geroni/igaa057.657 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 203-203

Author(s):

Ling Han ◽

Robert Kerns ◽

Melissa Skanderson ◽

Stephen Luther ◽

Samah Fodeh ◽

...

Keyword(s):

Primary Care ◽

Language Processing ◽

National Policy ◽

Female Gender ◽

Estimating Equation ◽

Chiropractic Care ◽

Veterans Health ◽

Health Administration ◽

Integrative Health ◽

Spatial Confounding

Abstract Complementary and integrative health (CIH) approaches are recommended in national policy guidelines as viable options for managing chronic pain, yet their use among Veterans has been suboptimal, especially for older Veterans. We identified 64,444 Veterans with a diagnosis of musculoskeletal disorders (MSD) who reported a moderate to severe pain intensity during primary care visits in 2013 from the Veterans Health Administration (VHA) electronic records. Using natural language processing (NLP), CIH use (acupuncture, chiropractic care and massage) was documented for 8169 (6.5%) of 125408 primary care visits in providers’ progress notes. Compared to their younger counterparts, older Veterans aged ≥ 65 years had 21% lower likelihood of using CIH during the year [Odds Ratio (OR): 0.79; 95% Confidence Intervals (CI): 0.73, 0.86] after accounting for demographic, clinical, temporal and spatial confounding using a generalized estimating equation logistic model. Non-white race/ethnicity, tobacco use, medical comorbidities and diagnosis of alcohol or substance use disorders were independently associated with less CIH use (ORs ranging 0.97-0.80, p<0.03-0.0001); whereas female gender, being married and number of MSD diagnoses were associated with greater CIH use (ORs ranging 1.13-1.30, p<0.0001). Redefining CIH use as chiropractic care alone [4.8% person-visits; OR: 0.78 (95% CI: 0.70, 0.86)] or incorporating structured data [9.0% person-visits; OR: 0.76 (95% CI: 0.70-0.82)] in the adjusted GEE model derived consistent results. Research to identify and address barriers to CIH use among older Veterans is encouraged.

Download Full-text

Outcomes of Primary Care for People With Dementia: What’s Important?

Innovation in Aging ◽

10.1093/geroni/igaa057.533 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 164-165

Author(s):

Laura Wray ◽

Bonnie Vest ◽

Laura Brady ◽

Christina Vair ◽

Gregory Beehler ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health And Safety ◽

Limited Attention ◽

Veterans Health ◽

Cognitive Screening ◽

Health Administration ◽

People With Dementia ◽

Primary Care Teams ◽

Care Outcomes

Abstract People with dementia (PWD) typically receive most of their healthcare in primary care (PC), but neurocognitive disorders can be challenging to recognize, assess, and manage in that setting. As a result, cognitive impairment in older adults is often missed or not addressed until later stages. The result is poor management of comorbid health conditions, increased healthcare utilization, and negative outcomes for the patient and family. Further, strategies for improvement and barriers to high quality PC for PWD have received limited attention. To improve PC for PWD, it is essential to understand what care outcomes should be targeted. To address this gap, we used a qualitative approach to examine potential outcomes of PC from the perspectives of older adults, family caregivers, primary care teams, and geriatrics specialists (n=79) from two Veterans Health Administration healthcare systems. Participants were interviewed individually or in focus groups. A directed content analysis based on the adapted Donabedian model was employed and expanded to fully capture transcript content. Three main categories of outcomes were identified: Personhood (i.e., independence), Physical Health and Safety, and Quality of Life. Regardless of participant type, respondents focused on similar desired outcomes and, notably, identified outcomes as important for both patients and their broader social context (i.e., caregivers, family). Discussion will: show how findings align with work conducted in specialty and residential care; describe how challenges to attaining these outcomes in PC can be overcome; and, challenge cognitive screening recommendations for PC that are based primarily on risk/benefit analysis of medication-focused outcomes.

Download Full-text

Evaluation of Mobile Tablet Computers for Use in the Veterans Health Administration

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857919081004 ◽

2019 ◽

Vol 8 (1) ◽

pp. 18-22

Author(s):

Jennifer Herout ◽

Kathleen L. Frisbee ◽

Nancy R. Wilck ◽

Margo Kabel ◽

Deyne Bentt ◽

...

Keyword(s):

Veterans Health Administration ◽

Clinical Settings ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration ◽

Clinical Environment ◽

Healthcare Organizations ◽

Advantages And Disadvantages ◽

Facilitators And Barriers ◽

Device Use

The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.

Download Full-text